Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain
Open accessAbstract
Background: Psychological inflexibility based on an acceptance and commitment therapy model is theoretically well-established as a process to exacerbate psychological distress, such as depressive symptoms and sleep disturbance. This study aimed to examine the associations of psychological inflexibility with depressive symptoms and sleep distribution. We hypothesized that psychological inflexibility would be associated with higher levels of depressive symptoms and sleep disturbance in women with chronic pain. Methods: Female college students in Japan answered a questionnaire on pain status, treatment, and psychological inflexibility as measured by the Acceptance and Action Questionnaire-Ⅱ before answering questionnaires on depressive symptoms and sleep disturbance eight months after. Results: Women with chronic pain (n = 320) reported more severe depressive symptoms and sleep disturbances compared to women without chronic pain (n = 90). Hierarchical multiple regressions revealed that psychological inflexibility predicted higher levels of depressive symptoms and sleep disturbance, independent of the pain intensity, whether they consulted a doctor or used pain medication. Conclusion: Based on our findings self-management interventions aimed at reducing psychological inflexibility should be developed for individuals who are experiencing chronic pain.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Psychological inflexibility contributes to insomnia severity, beyond the effect of neuroticism, and could mediate the relation between neuroticism and insomnia severity.
“Kato (32) found that psychological inflexibility contributes to insomnia severity, beyond the effect of neuroticism, and could mediate the relation between neuroticism and insomnia severity.”
From The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia (2023) · cites this paper as Kato (32)
The Results and Discussion report that psychological inflexibility predicted sleep disturbance in Japanese female college students with chronic pain after accounting for pain intensity, treatment, and medication use. The Discussion mentions neuroticism only as another trait related to sleep disturbance and calls for further research; it does not show an effect beyond neuroticism or test mediation between neuroticism and insomnia severity. The Limitations also caution that the observed association does not establish causation. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPsychological flexibility can predict levels of psychological health problems such as depressive symptoms, anxiety, and sleep disturbance.
“previous studies that have shown PF can predict the levels of psychological health problems, such as depressive symptoms, anxiety as well as sleep disturbance”
From The Psychological Flexibility in Epilepsy Questionnaire (PFEQ): Psychometric properties of the Persian version (2022) · cites this paper as [49]
The Results and Discussion report that psychological inflexibility predicted depressive symptoms and sleep disturbance in Japanese female college students with chronic pain. The paper does not report a finding for anxiety, and it measured psychological inflexibility rather than psychological flexibility directly. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe current study's results are in line with previous studies on psychological flexibility and psychological health and quality of life.
“In general, the results in the current study are in line with previous studies that have shown PF can predict the levels of psychological health problems, such as depressive symptoms, anxiety as well as sleep disturbance and PF is related to the quality of life outcomes [49–51]”
From The Psychological Flexibility in Epilepsy Questionnaire (PFEQ): Psychometric properties of the Persian version (2022) · cites this paper as [49]
The Discussion and Conclusions report that psychological inflexibility was associated with higher depressive symptoms and sleep disturbance in Japanese female college students with chronic pain. The cited paper does not report findings on anxiety or quality-of-life outcomes, so it supports only part of the citing sentence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPsychological flexibility is related to quality of life outcomes.
“PF is related to the quality of life outcomes [49–51]”
From The Psychological Flexibility in Epilepsy Questionnaire (PFEQ): Psychometric properties of the Persian version (2022) · cites this paper as [49]
The Results and Discussion report that psychological inflexibility was associated with depressive symptoms and sleep disturbance in Japanese female college students with chronic pain. Those are relevant well-being outcomes, but the paper did not measure quality of life directly, so it supports a narrower claim than the citing sentence makes. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Hayes, S. C. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80013-3 · Cited by 2,493 · see citing works
Validity of four pain intensity rating scales
Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2011) · Pain · doi:10.1016/j.pain.2011.07.005 · Cited by 1,872 · see citing works
The association of sleep and pain: an update and a path forward
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013) · The Journal of Pain · doi:10.1016/j.jpain.2013.08.007 · Cited by 1,620 · see citing works
Hayes, S. C. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.11.006 · Cited by 785 · see citing works
The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure?
Thong, I. S. K., Jensen, M. P., Miró, J., & Tan, G. (2018) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2018-0012 · Cited by 652 · see citing works
Persistent pain and depression: A biopsychosocial perspective
Campbell, L. C., Clauw, D. J., & Keefe, F. J. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00545-6 · Cited by 362 · see citing works
McCracken, L. M., & Gutiérrez-Martínez, O. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.004 · Cited by 283 · cited 1× · see citing works
“Moreover, another study [20] on patients with chronic pain conducted an ACT-based treatment for chronic pain and found that psychological inflexibility, pain intensity, and depressive symptoms at the three-month follow-up was reduced by the treatment, and that the change in score of psychological inflexibility at pre-…”
BackgroundWicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2010.05.001 · Cited by 259 · see citing works
Psychological Flexibility as a Resilience Factor in Individuals with Chronic Pain
Gentili, C., Rickardsson, J., Zetterqvist, V., Simons, L. E., Lekander, M., & Wicksell, R. K. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02016 · Cited by 148 · see citing works
Heapy, A. A., Higgins, D. M., Cervone, D., Wandner, L., Fenton, B. T., & Kerns, R. D. (2015) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000185 · Cited by 128 · see citing works
Vowles, K. E., & McCracken, L. M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.09.011 · Cited by 122 · see citing works
French, K., Golijani-Moghaddam, N., & Schröder, T. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.08.002 · Cited by 100 · cited 1× · see citing works
“Moreover, recently, some self-management practices for chronic pain based on the ACT model have been developed, and their efficacy has been reported [50,51].”
BackgroundMcCracken, L. M., Williams, J. L., & Tang, N. K. Y. (2011) · Pain Medicine · doi:10.1111/j.1526-4637.2011.01115.x · Cited by 96 · see citing works
McCracken, L. M., Gutiérrez-Martínez, O., & Smyth, C. (2013) · Health Psychology · doi:10.1037/a0028093 · Cited by 87 · cited 1× · see citing works
“A similar finding emerged in previous studies [17,21,31].”
ResultAndrés-Rodríguez, L., Borràs, X., Feliu-Soler, A., Pérez-Aranda, A., Rozadilla-Sacanell, A., Montero-Marin, J., Maes, M., & Luciano, J. V. (2019) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2019.02.030 · Cited by 87 · see citing works
Psychological flexibility, acceptance and commitment therapy, and chronic pain
Scott, W., & McCracken, L. M. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2014.12.013 · Cited by 82 · see citing works
Lin, J., Klatt, L.-I., McCracken, L. M., & Baumeister, H. (2018) · PAIN · doi:10.1097/j.pain.0000000000001134 · Cited by 76 · see citing works
Sex differences in pain responses
Sorge, R. E., & Strath, L. J. (2018) · Current Opinion in Physiology · doi:10.1016/j.cophys.2018.05.006 · Cited by 73 · see citing works
Daly-Eichenhardt, A., Scott, W., Howard-Jones, M., Nicolaou, T., & McCracken, L. M. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01326 · Cited by 69 · see citing works
Mosher, C. E., Tometich, D. B., Hirsh, A., Rand, K. L., Johns, S. A., Matthias, M. S., Outcalt, S. D., Bricker, J., Schneider, B., Mina, L., et al. (2017) · Psycho-Oncology · doi:10.1002/pon.4283 · Cited by 34 · cited 2× · see citing works
“Generally, existing studies [32,33] have shown that pain intensity is associated with higher levels of sleep disturbance in individuals with chronic pain; however, our results were inconsistent with those of previous studies.”
BackgroundResultBenjamin, J. Z., Harbeck-Weber, C., Ale, C., & Sim, L. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.01.003 · Cited by 31 · see citing works
Borgogna, N. C., McDermott, R. C., Berry, A., Lathan, E. C., & Gonzales, J. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.01.011 · Cited by 29 · see citing works
The “self” in pain: The role of psychological inflexibility in chronic pain adjustment
Kwok, S. S. W., Chan, E. C. C., Chen, P. P., & Lo, B. C. Y. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9750-x · Cited by 24 · see citing works
Flagged first, then by citations
Research works printed but not linked: 30
- [1]Breivik H. Eisenberg E. O’Brien T. The individual and societal burden of chronic pain in Europe: The case for strategic prioritisation and action to improve knowledge and availability of appropriate care BMC Public Health 2013 13 1229 10.1186/1471-2458-13-1229 24365383 PMC3878786 · DOI · Paper page
- [2]Steingrímsdóttir Ó.A. Landmark T. Macfarlane G.J. Nielsen C.S. Defining chronic pain in epidemiological studies: A systematic review and meta-analysis Pain 2017 158 2092 2107 10.1097/j.pain.0000000000001009 28767506 · DOI
- [3]Mogil J.S. Sex differences in pain and pain inhibition: Multiple explanations of a controversial phenomenon Nat. Rev. Neurosci. 2012 13 859 866 10.1038/nrn3360 23165262 · DOI · Paper page
- [4]Miller L.R. Cano A. Comorbid chronic pain and depression: Who is at risk? J. Pain 2009 10 619 627 10.1016/j.jpain.2008.12.007 19398383 · DOI
- [6]Boakye P.A. Olechowski C. Rashiq S. Verrier M.J. Kerr B. Witmans M. Baker G. Joyce A. Dick B.D. A critical review of neurobiological factors involved in the interactions between chronic pain, depression, and sleep disruption Clin. J. Pain 2016 32 327 336 10.1097/AJP.0000000000000260 26035521 · DOI
- [7]Dzierzewski J.M. Ravyts S. Griffin S.C. Rybarczyk B. Sleep and pain: The role of depression Curr. Sleep Med. Rep. 2019 5 173 180 10.1007/s40675-019-00159-6 · DOI
- [9]Holmes A. Christelis N. Arnold C. Depression and chronic pain Med. J. Aust. 2013 199 S17 S20 10.5694/mja12.10589 25370278 · DOI
- [10]Thompson T. Correll C.U. Gallop K. Vancampfort D. Stubbs B. Is pain perception altered in people with depression? A systematic review and meta-analysis of experimental pain research J. Pain 2016 17 1257 1272 10.1016/j.jpain.2016.08.007 27589910 · DOI
- [11]Freedom T. Evans R.W. Headache and sleep Headache 2013 53 1358 1366 10.1111/head.12178 23848227 · DOI
- [13]Whibley D. AlKandari N. Kristensen K. Barnish M. Rzewuska M. Druce K.L. Tang N.K.Y. Sleep and pain: A systematic review of studies of mediation Clin. J. Pain 2019 35 544 558 10.1097/AJP.0000000000000697 30829737 PMC6504189 · DOI
- [16]Scott W. McCracken L.M. Trost Z. A psychological flexibility conceptualisation of the experience of injustice among individuals with chronic pain Br. J. Pain 2014 8 62 71 10.1177/2049463713514736 26516537 PMC4590133 · DOI
- [18]Kato T. Kadota M. Shimoda S. Effects of coping flexibility in young women on depressive symptoms during chronic pain Behav. Med. 2019 10.1080/08964289.2019.1708250 31886738 · DOI
- [22]Scott W. Daly A. Yu L. McCracken L.M. Treatment of chronic pain for adults 65 and over: Analyses of outcomes and changes in psychological flexibility following interdisciplinary acceptance and commitment therapy (ACT) Pain Med. 2017 18 252 264 10.1093/pm/pnw073 28204691 · DOI
- [23]Talaei-Khoei M. Fischerauer S.F. Lee S. Ring D. Vranceanu A. Pain catastrophizing mediates the effect of psychological inflexibility on pain intensity and upper extremity physical function in patients with upper extremity illness Pain Pract. 2017 17 129 140 10.1111/papr.12494 27739246 · DOI
- [24]Yang S. McCracken L.M. Moss-Morris R. Psychological treatment needs for chronic pain in Singapore and the relevance of the psychological flexibility model Pain Med. 2017 18 1679 1694 10.1093/pm/pnw175 27492743 · DOI
- [27]Keinonen K. Kyllönen H. Astikainen P. Lappalainen R. Early sudden gains in an acceptance and values-based intervention: Effects on treatment outcome for depression and psychological flexibility J. Contextual Behav. Sci. 2018 10 24 30 10.1016/j.jcbs.2018.07.010 · DOI · Paper page
- [30]Yu L. Scott W. McCracken L.M. Change in fatigue in acceptance and commitment therapy-based treatment for chronic pain and its association with enhanced psychological flexibility Eur. J. Pain 2020 24 234 247 10.1002/ejp.1480 31487413 · DOI
- [31]McCracken L.M. Zhao-O’Brien J. General psychological acceptance and chronic pain: There is more to accept than the pain itself Eur. J. Pain 2010 14 170 175 10.1016/j.ejpain.2009.03.004 19349199 · DOI · Paper page
- [36]Xie C.J. Xu X.H. Ou M.J. Chen Y.Y. Chinese version of the Psychological Inflexibility in Pain Scale for Cancer Patients reporting chronic pain Cancer Nurs. 2019 10.1097/NCC.0000000000000772 PMC8061340 31651462 · DOI
- [39]Treede R. Rief W. Barke A. Aziz Q. Bennett M.I. Benoliel R. Cohen M. Evers S. Finnerup N.B. First M.B. Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11) Pain 2019 160 19 27 10.1097/j.pain.0000000000001384 30586067 · DOI · Paper page
- [40]Kato T. Impact of psychological inflexibility on depressive symptoms and sleep difficulty in a Japanese sample Springerplus 2016 5 712 10.1186/s40064-016-2393-0 27375981 PMC4908084 · DOI · Paper page
- [42]Ong C.W. Lee E.B. Levin M.E. Twohig M.P. A review of AAQ variants and other context-specific measures of psychological flexibility J. Contextual Behav. Sci. 2019 12 329 346 10.1016/j.jcbs.2019.02.007 · DOI · Paper page
- [44]Kato T. Effects of waiting patiently as coping strategy for an interpersonal stressor on depressive symptoms Anxiety Stress Coping 2020 10.1080/10615806.2020.1795139 32672068 · DOI
- [45]Kato T. Development of the Sleep Quality Questionnaire in healthy adults J. Health Psychol. 2014 19 977 986 10.1177/1359105313482168 23720542 · DOI
- [46]Johns M.W. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale Sleep 1991 14 540 545 10.1093/sleep/14.6.540 1798888 · DOI · Paper page
- [47]Kendzerska T.B. Smith P.M. Brignardello-Petersen R. Leung R.S. Tomlinson G.A. Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review Sleep Med. Rev. 2014 18 321 331 10.1016/j.smrv.2013.08.002 24135493 · DOI · Paper page
- [49]Mendoza H. Tully E.C. Goodnight B. Gray J. Masuda A. The indirect effect of self-concealment on distress through psychological inflexibility in Asian American, Black American, and White American college students Pers. Individ. Dif. 2018 126 93 98 10.1016/j.paid.2018.01.024 · DOI
- [52]Institute of Medicine Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research National Academies Press Washington, DC, USA 2011 22553896
- [53]Rosenberg J.M. Bilka B.M. Wilson S.M. Spevak C. Opioid therapy for chronic pain: Overview of the 2017US Department of Veterans Affairs and US Department of Defense clinical practice guideline Pain Med. 2018 19 928 941 10.1093/pm/pnx203 29025128 · DOI
- [54]Mehuys E. Crombez G. Paemeleire K. Adriaens E. van Hees T. Demarche S. Christiaens T. van Bortel L. van Tongelen I. Remon J.P. Self-medication with over-the-counter analgesics: A survey of patient characteristics and concerns about pain medication J. Pain 2019 20 215 223 10.1016/j.jpain.2018.09.003 30273688 · DOI
Cited by
Sorted by citations
Paulos-Guarnieri, L., Linares, I. M. P., & El Rafihi-Ferreira, R. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.11.001 · Cited by 48 · see citing works
El Rafihi-Ferreira, R., do Brasil do Carmo, M. M. I., Bassolli, L., Hasan, R., Aizawa, I. M. N., & Toscanini, A. C. (2022) · Psicologia: Reflexão e Crítica · doi:10.1186/s41155-022-00243-x · Cited by 17 · see citing works
“Recent studies have demonstrated the association between psychological inflexibility and the severity of insomnia and sleep problems (Kato, 2016; Kato, 2020; McCracken et al., 2021).”
BackgroundResultInfluentialDavoudi, M., Lundgren, T., Jansson-Fröjmark, M., Saeedipour, Z., & Badinlou, F. (2022) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2022.108672 · Cited by 12 · see citing works
The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia
Habibi Asgarabad, M., Doos Ali Vand, H., Salehi Yegaei, P., Hooman, F., Ahmadi, R., Baglioni, C., & Moradi, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1162729 · Cited by 10 · see citing works
“Kato (2020) found that psychological in�exibility contributes to insomnia severity, beyond the effect of neuroticism, and could mediate the relation between neuroticism and insomnia severity.”
Background
- Authors
- Kato, T.
- Affiliations
- Toyo University (JP)
- Corresponding author
- Kato, Tsukasa
- ORCID
- Kato, Tsukasa
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2020-10-12
- Volume
- 17
- Issue
- 20
- Pages
- 7426
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC7600104
- OpenAlex
- W3091941656
- Cited by
- 22
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 4 · 2022: 7 · 2021: 2
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Japan Society for the Promotion of Science (19K03326)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- psychological inflexibility, depressive symptoms, sleep disorders, chronic pain, young women, acceptance and commitment therapy, Acceptance and Action Questionnaire-II, self-management interventions, pain intensity, university students
- MeSH terms
- Depression, Female, Humans, Japan, Surveys and Questionnaires, Sleep, Sleep Wake Disorders, Young Adult, Chronic Pain, Acceptance and Commitment Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
